The clinical use of Fracture Risk Assessment Tool (FRAX) without bone mineral density (BMD) can be useful in identifying adults with type 1 diabetes at elevated risk for major osteoporotic fracture, according to results of a study published in Bone.

Elevated fracture risk in individuals with type 1 diabetes cannot be explained by BMD alone. While FRAX underestimates fracture prediction in people with type 2 diabetes, its utility has not been studied in type 1 diabetes.

To evaluate the association of FRAX without BMD and the risk for major osteoporotic fracture in type 1 diabetes, data from eligible 757 participants (type 1 diabetes n=346; control n=411) from the CACTI study were analyzed. Participants completed 4 visits over 18 years. The control group primarily consisted of people — spouses, friends, or neighbors — close to participants with type 1 diabetes who were not diagnosed with type 1 diabetes over the course of the study.

There was no difference in body mass index between the 2 groups; however, the type 1 diabetes group had a significantly higher prevalence of rheumatoid arthritis (5.8% vs 1.2%; P =.0003) and history of fracture (64.4% vs 56%; P =.02).


Continue Reading

Over an average of 8.5 plus or minus 0.7 years of follow up for controls and 8.7 plus or minus 0.8 years of follow up for participants with type 1 diabetes, incident major ostoporotic fracture was reported in 45 participants, while incident hip fractures were reported in 6 participants. Incidence of new major osteoporotic fracture was significantly higher in the type 1 diabetes group (7.8% vs 4.4%; P =.048). When adjusting for age, sex, and diabetes status, FRAX score without BMD was the only variable significantly associated with risk for major osteoporotic fracture (hazard ratio, 1.08; 95% CI, 1.02-1.14; P =.006).

Study results indicate that FRAX without BMD may be a useful tool for therapeutic decision-making for individuals with type 1 diabetes given its powerful ability to predict major osteoporotic fracture.

Limitations to this study include the self-reporting nature of data collection regarding fractures and fracture history. Future research with longer follow-up periods is warranted.

Reference

Champakanath A, Keshawarz A, Pyle L, Snell-Bergeon JK, Shah VN. Fracture risk assessment (FRAX) without BMD and risk of major osteoporotic fractures in adults with type 1 diabetes. Published online August 21, 2020. Bone. doi: 10.1016/j.bone.2020.115614

This article originally appeared on Endocrinology Advisor